title: Dental status, dental rehabilitation procedures, demographic and oncological data as potential risk factors for infected osteoradionecrosis of the lower jaw after radiotherapy for oral neoplasms: a retrospective evaluation.
abstract: OBJECTIVE
  Retrospective evaluation of the dental status of patients with oral cancer before radiotherapy, the extent of dental rehabilitation procedures, demographic and radiotherapy data as potential risk factors for development of infected osteoradionecrosis of the lower jaw.
  
  
  METHODS
  A total of 90 patients who had undergone radiotherapy for oral cancer were included into this retrospective evaluation. None of them had distant metastases. After tumour surgery the patients were referred to an oral and maxillofacial surgeon for dental examination and the necessary dental rehabilitation procedures inclusive potential tooth extraction combined with primary soft tissue closure. Adjuvant radiotherapy was started after complete healing of the gingiva (> 7 days after potential extraction). The majority of patients (n = 74) was treated with conventionally fractionated radiotherapy with total doses ranging from 50-70Gy whereas further 16 patients received hyperfractionated radiotherapy up to 72Gy. The records of the clinical data were reviewed. Furthermore, questionnaires were mailed to the patients' general practitioners and dentists in order to get more data concerning tumour status and osteoradionecrosis during follow-up.
  
  
  RESULTS
  The patients' dental status before radiotherapy was generally poor. On average 10 teeth were present, six of them were regarded to remain conservable. Extensive dental rehabilitation procedures included a mean of 3.7 tooth extractions. Chronic periodontitis with severe attachment loss was found in 40%, dental biofilm in 56%. An infected osteoradionecrosis (IORN) grade II according to (Schwartz et al., Am J Clin Oncol 25:168-171, 2002) was diagnosed in 11 of the 90 patients (12%), mostly within the first 4 years after radiotherapy. We could not find significant prognostic factors for the occurrence of IORN, but a trendwise correlation with impaired dental status, rehabilitation procedures, fraction size and tumour outcome.
  
  
  CONCLUSIONS
  The occurrence of IORN is an important long-term side effect of radiotherapy for oral cancers. From this data we only can conclude that a poor dental status, conventional fractionation and local tumour progression may enhance the risk of IORN which is in concordance with the literature.
authors.affiliation: Department of Radiotherapy and Radiooncology, Saarland University Medical Center, Kirrberger Str, 1, D-66421 Homburg, Germany. marcus.niewald@uks.eu.
authors.forename: Marcus
authors.initials: M
authors.lastname: Niewald
authors.forename: Jochen
authors.initials: J
authors.lastname: Fleckenstein
authors.forename: Kristina
authors.initials: K
authors.lastname: Mang
authors.forename: Henrik
authors.initials: H
authors.lastname: Holtmann
authors.forename: Wolfgang J
authors.initials: WJ
authors.lastname: Spitzer
authors.forename: Christian
authors.initials: C
authors.lastname: Rübe
mesh_terms: D003729:Dental Care; D005260:Female; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000209:etiology*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D010025:Osteoradionecrosis / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014076:Tooth Diseases / Q000150:complications*